Individual
BIANCA AL-TAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
785 ANTHONY DRIVE, ANTHONY, NM 88021-2671
(575) 882-5100
Mailing address
PO BOX 2671, ANTHONY, NM 88021-2671
(575) 882-5100
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35650338
—
NM
Enumeration date
08/30/2018
Last updated
03/18/2025
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